Understanding Migraine Headaches

Just about everyone has headaches, but a migraine isn't just a bad headache. A migraine headache is a complex condition of the nervous system. It's often described as an intense pulsing or throbbing pain that usually occurs in one area of the head. Migraine attacks may cause severe, debilitating pain for hours to days, necessitating the need to retreat to a dark, quiet place.

A migraine headache is often accompanied by additional symptoms, such as nausea, vomiting, and sensitivity to light and sound. About one-third of affected people can predict the start of a migraine because they experience sensory warning symptoms (also called "aura"). These early-warning symptoms may include flashes of light, blind spots, zig-zag lines, temporary loss of vision, or tingling in the arm or leg.

What Causes Migraines?

Scientists still don't know for certain what causes migraines. Migraines could involve disturbances in nerve pathways and brain chemicals that affect blood vessels near the brain's surface. The blood vessels swell, sending pain to the brain stem, an area that processes pain information. A genetic predisposition to migraine may exist, as it often runs in families.

Recurring migraine attacks are caused by a number of different triggers. Recognizing and recording individual triggers in a headache diary or calendar may be useful in helping to prevent future attacks.

There is no cure for migraine. There are two ways to approach treating migraine with medicine. You can take medicine during attacks to relieve symptoms (acute treatment), or you can take medicine daily to prevent or reduce attacks and lessen the intensity of the pain (preventive treatment).

Acute treatment consists of over-the-counter pain relievers (or analgesics), such as acetaminophen, aspirin, and ibuprofen. If these products don't work for you, your doctor may prescribe medication that includes a stronger analgesic and/or a drug that acts more specifically on the cause of migraines. These migraine-specific treatments may include drugs from the "triptan" class (such as sumatriptan, almotriptan, or zolmitriptan), or "ergot-type" products such as dihydroergotamine nasal spray. If needed, drugs for nausea and vomiting may also be prescribed. The sooner these treatments are administered, the more effective they are.

If you have frequent migraine attacks, if your attacks don't respond consistently to migraine-specific treatments, or if acute medications are ineffective or can't be used because of other medical problems, preventive treatment may be prescribed. Certain drugs originally developed for epilepsy, depression, or high blood pressure have been shown to be effective in preventing migraine attacks. Botulinum toxin A, which is injected into muscles in the head and neck, has also been shown to be effective in prevention of chronic migraine.

What Are Rebound Headaches?

Rebound headaches (or medication-overuse headaches) are caused by frequent use of headache medication. They are also the most common cause of progression from episodic migraine (where attacks occur occasionally or infrequently) to chronic migraine (where attacks occur more frequently or regularly).

If you use acute over-the-counter and prescription drugs too often (more than two or three days per week), it can create a headache-worsening pattern that results in more headaches and the need to take more medicine. This pattern is harmful, and while in this cycle, other treatments often don't work. The only way to break this cycle is to stop the pattern of overuse, which should be done under a doctor's care.

Also, overuse of certain anti-inflammatory drugs, such as ibuprofen or naproxen sodium, may cause stomach irritation and even ulcers. Excessive use of acetaminophen may increase the risk of liver problems in certain people.

Can Migraines Increase the Risk of Stroke?

Although the symptoms of severe migraine attacks can cause fear that you're having a stroke, the likelihood of a migraine causing a stroke is small. It is true, however, that in people younger than 40 years (or in someone with long-term, untreated migraine with aura), the most common associated factor for stroke is migraine.